Trauma System Battles

New Regulations for Trauma Centers in Florida

Earlier this year, Florida Governor Rick Scott signed a bill that could end the recent legal drama surrounding Florida’s trauma centers.

The compromise law is mostly concerned with how many trauma centers the state can have. The new law changes the number of trauma-service areas in the state from 19 to 18 and lowers the cap on trauma centers to 35 from 44. Population rules are still being used meaning there can be no more than two trauma centers in an area with 1.25 million people.

The new bill also mandates that the Florida Department of Health create an analysis of the statewide trauma system every three years starting in 2020. Under an advisory panel – which must be formed by October 1 and meet quarterly – it will make recommendations to the DOH. The panel will consist of 12 people and all be appointed by the governor.

The application process under the new law requires the DOH to accept a letter of intent to open a new trauma center only if there has to be, said state Rep. Jay Trumbull, R-Panama City, who was one to sponsor the new law.

The fight over trauma center came after HCA – a private corporation – moved to open several trauma centers. This drew legal challenges from hospitals that have long operated trauma facilities.

Unlike emergency rooms, trauma centers are specifically designated to handle catastrophic injuries and are regulated by the Department of Health.

A Level I trauma center is one that has doctors on site as well as having doctors on call. It is capable of providing total care from prevention through rehabilitation. A Level II trauma center has doctors on call. It is able to initiate definitive care for all patients. A Level III provides prompt assessment, resuscitation, surgery, intensive care and stabilization of injured patients and emergency operations. A Level IV center can provide advanced trauma life support, evaluation, stabilization and diagnostic capabilities. Finally, a Level V center provides initial evaluation, stabilization and diagnostic capabilities, and prepares patients for transfer to other areas of care.

Being admitted to a trauma center is generally provided by paramedics to respond to emergency calls. Using their judgment and a checklist provided by the DOH, paramedics decide whether a trauma center is needed. Paramedics then take the person to the nearest trauma center.

The closest one here in Polk County is the Lakeland Regional Medical Center. However, under the new law, more trauma centers have been given permission to open in Central Florida. The Osceola Regional Medical Center in Kissimmee and Central Florida Regional Medical Center in Sanford opened Level II trauma centers. HCA owns both of these and they started accepting patients in May.

The bill does grandfather into the new system all verified and provisionally approved trauma centers. Those centers include Kendall Regional Medical Center’s Level I trauma center, which is allowed to operate a pediatric trauma center; Orange Park Medical Center’s Level II trauma center, and Aventura Hospital & Medical Center’s level II trauma center, all owned by HCA. Northside Hospital in St. Petersburg, is prevented from moving ahead with a trauma center.

Despite unanimous votes in both state houses, there are still obstacles as lawsuits have been filed. The Nicklaus Children’s Hospital filed a challenge in Leon County seeking an injunction to block part of the law that would allow Kendall Regional Medical Center to operate a Level I center. Nicklaus Children’s Hospital claims it will “suffer irreparable harm because any final approval of Kendall’s Level I status, and the significant damage flowing therefrom cannot be undone.”

Attorneys for Nicklaus said the interests of private businesses should not be more valuable than those of the patient. This, Nicklaus attorneys claim, violates the state Constitution because it unfairly benefits one private corporation which is not allowed.

This bill can potentially impact many different hospitals and physicians throughout the state. The long-term impact of the bill remains to be seen. However, there is a chance that it could help solve the state’s trauma system problems for now.